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Intracerebral haemorrhage in bacterial meningitis
Shahrzad S Deliran1, Matthijs C Brouwer1, Diederik van de Beek1
1Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, University of Amsterdam, Meibergdreef 9, PO Box 22660, Amsterdam 1100DD, Netherlands.
Insights
Intracerebral haemorrhage (ICH) is a rare but serious complication of bacterial meningitis, occurring in 1.9% of cases. This condition significantly increases the risk of death and long-term neurological disability.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Bacterial meningitis can lead to severe neurological complications.
- Intracerebral haemorrhage (ICH) is a potential, though infrequent, complication of bacterial meningitis.
- Understanding the characteristics and outcomes of ICH in this context is crucial for patient management.
Purpose of the Study:
- To investigate the incidence, clinical presentation, radiological findings, and outcomes of intracerebral haemorrhage (ICH) in patients with community-acquired bacterial meningitis.
- To identify risk factors and associated conditions for ICH in bacterial meningitis.
- To compare the outcomes of bacterial meningitis patients with and without ICH.
Main Methods:
- A prospective nationwide cohort study was conducted in the Netherlands from 2006 to 2018.
- Data on clinical characteristics, radiological patterns, and outcomes were collected for patients with bacterial meningitis.
- Intracerebral haemorrhage (ICH) was identified and analyzed in relation to patient demographics, comorbidities, and clinical course.
Main Results:
- Intracerebral haemorrhage (ICH) occurred in 1.9% of bacterial meningitis cases (44/2306).
- ICH was associated with higher rates of mortality (55% vs. 16%) and unfavorable outcomes (89% vs. 36%) compared to non-ICH cases.
- Neurological sequelae were frequent in ICH survivors (75% vs. 12%).
Conclusions:
- Intracerebral haemorrhage (ICH) is a rare but severe complication of bacterial meningitis, particularly in patients with endocarditis, cerebral infarction, or on anticoagulant therapy.
- ICH significantly elevates the risk of death and morbidity in bacterial meningitis patients.
- Prompt recognition and management of ICH are vital for improving outcomes in bacterial meningitis.
Objective:
To determine the incidence, clinical course, radiological patterns, and clinical outcome of intracerebral haemorrhage (ICH) complicating community-acquired bacterial meningitis.
Methods:
The clinical characteristics and outcome of patients with ICH complicating bacterial meningitis were studied in a prospectively nationwide cohort in the Netherlands performed from 2006 to 2018.
Results:
ICH was identified in 44 of 2306 episodes of bacterial meningitis (1.9%). Nine of these patients (20%) were diagnosed with ICH on admission and 35 (80%) during clinical course after a median of 5 days (1-9). ICH occurred in 4 patients with endocarditis (9%), 9 patients on anticoagulation (vitamin K antagonists and heparin; 20%), and 10 patients with cerebral infarctions (23%). In 31 patients (70%) ICH was a lobar haematoma. ICH in bacterial meningitis was associated with high rates of death (24 of 44 [55%] vs. 346 of 2200 [16%]; P < 0.001) and unfavourable outcome compared to non-ICH patients (39 of 44 [89%] vs. 798 of 2200 [36%]; P < 0.001). Neurological sequelae on discharge occurred frequently in ICH survivors compared to non-ICH patients (15 of 20 [75%] vs. 203 of 1669 [12%]; P < 0.001).
Conclusions:
ICH is a rare but severe complication in patients with bacterial meningitis occurring in those with endocarditis, cerebral infarction, and anticoagulant use. ICH complicating bacterial meningitis is associated with high rates of death and morbidity.
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